2 Out of 3 Medical Students Don’t Know When to Wash Their Hands

It’s cold and flu season, which means you should be washing your hands — a lot. And that rule should apply to health care workers most of all, to protect not just themselves but their patients. Problem is, most doctors are confused about when they’re supposed to hit the sink, a new study of medical students finds.

Researchers at Hannover Medical School in Germany surveyed 85 medical students who were about to enter their clinical training — when they deal with actual patients. The surveys were administered as part of a lecture class that students must pass before initiating patient contact.

The doctors-to-be were given seven scenarios, five of which required hand-washing: before contact with patients, before preparing IV fluids, after removing gloves, after contacting patients’ beds and after contact with vomit. (The other two scenarios did not require hand-washing.)

Only 1 in 5 students correctly identified what to do in all seven situations. And just 1 in 3 got all five hand-washing scenarios correct. Most students knew that they were supposed to wash their hands before contacting a patient, after touching their bed and after contacting vomit, but 15% to 20% could not correctly identify the other two hand-washing situations. (Last month, a study found that wearing gloves made health care workers less likely to wash their hands, which is dismaying since germs can travel through latex gloves.)

From the results, published in the American Journal of Infection Control, it’s clear that doctors-in-training need more education about the importance of hand-washing, and more specifically, practical lessons on when to use either hand sanitizers or the sink. Previous studies have suggested that health care workers are confused about the protocol: a 2006 British survey found that 58% of medical students didn’t know when to use the alcohol-based hand sanitizers.

So how can health care workers improve on their hand-washing compliance? This is a source of constant concern and study in hospitals. One thing that helps is to remind them that it’s not only their own health, but also the health of their patients that’s at stake. So, the next time you’re in the hospital or at the doctor’s office, and your physician doesn’t wash his hands before beginning an exam, you might want to point him toward the sink.

Alice Park is a writer at TIME. Find her on Twitter at @aliceparkny. You can also continue the discussion on TIME’s Facebook page and on Twitter at @TIME.